NPIMap

Organization Active NPI

Activekidz and Adult Therapy Services

  • Physical Therapist
  • Watkinsville, GA
National Provider Identifier
1962633131
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5588 Issued in GA
Legal business name
ACTIVEKIDZ AND ADULT THERAPY SERVICES
Practice address
1071 Thomas Ave
Watkinsville, GA 30677-6073
Phone
(770) 207-6390
Fax
(678) 374-4855
NPI assigned
Aug 5, 2009
Last updated
Apr 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Cook, PTNPI 1295775955
Title
Owner
Phone
(770) 207-6390

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 5588 GA Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 3287 GA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 5359 GA

Addresses

Primary practice location

1071 Thomas Ave
Watkinsville, GA 30677-6073

Mailing address

1431 Capital Ave Ste 123
Watkinsville, GA 30677-1883
Phone (706) 338-8058

National Provider Directory

National Provider Directory

Locations

1431 Capital Ave
Ste 123
Watkinsville, GA 30677

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1962633131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 CAPITAL AVE STE 123",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306771883",
            "telephone_number": "706-338-8058",
            "fax_number": "678-374-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 THOMAS AVE",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306776073",
            "telephone_number": "770-207-6390",
            "fax_number": "678-374-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVEKIDZ AND ADULT THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-05",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-207-6390",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "5588",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "3287",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "5359",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.